Clinical, laboratorial, and therapeutic aspects of 46 children with Henoch-Schönlein purpura

Forty-six children with Henoch-Sch?nlein purpura were studied.Their clinical manifestations included palpable purpura in 100%, subcutaneous edema in 30%, arthritis/arthralgia in 78%, gastrointestinal involvement in 56% and renal abnormalities in 30%. Serum IgA was elevated in 12%, ASLO titers in 27% and microscopic hematuria and proteinuria were detected in 30% of the children, including two with nephrotic syndrome. Treatment with non-steroidal antiinflammatory drugs or corticosteroid was indicated in 43% of the children. Recurrence of the disease was observed in 22% and the prognosis seems to be related to severity of renal involvement.     

A case of deep sylvian meningioma (author's transl)

So called intracerebral or subcortical meningioma with no relation to the ventricles is extremely rare. In 1938 Cushing and Eisenhardt reported two cases of this type of tumor as "Deep Sylvian Meningiomas" The authors reported a case of "deep sylvian meningioma" because of its rarity and interesting diagnostical questions, and 16 cases reported in the literature were reviewed.     

Steroid pulse therapy in patients with encephalopathy associated with severe fever with thrombocytopenia syndrome

Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne infectious disease caused by the SFTS virus (SFTSV). Clinical symptoms of SFTS often involve encephalopathy and other central neurological symptoms, particularly in seriously ill patients; however, pathogenesis of encephalopathy by SFTSV is largely unknown. Herein, we present case reports of three patients with SFTS, complicated by encephalopathy, admitted to Tokushima University hospital: one patient was a 63-year-old man, while the other two were 83- and 86-year-old women. All of them developed disturbance of consciousness around the 7th day post onset of fever. After methylprednisolone pulse therapy of 500 mg/day, all of them recovered without any neurological sequelae. SFTSV genome was not detected in the cerebrospinal fluid of 2 out of the 3 patients that were available for examination. In these patients, disturbance of consciousness seemed to be an indirect effect of the cytokine storm triggered by SFTSV infection. We propose that short-term glucocorticoid therapy might be beneficial in the treatment of encephalopathy during early phase of SFTSV infection.     

Acute Myeloid Leukemia Developing with Acute Pancreatitis Mimicking Autoimmune Pancreatitis

A 33-year-old man was admitted to our hospital for fever and abdominal pain. A blood analysis revealed pancytopenia and increased serum pancreatic enzymes with disseminated intravascular coagulation. A detailed examination revealed acute pancreatitis, with diffuse swelling of the pancreas and diffuse beaded dilatation of the main pancreatic duct, which mimicked autoimmune pancreatitis complicated by acute myeloid leukemia. Systemic cytotoxic chemotherapy led to the remission of leukemia and pancreatitis. We hypothesized that the etiology of acute pancreatitis was invasion of leukemia cells. Acute pancreatitis is rare as a symptom of leukemia; however, we should consider the possibility of leukemia during the differential diagnosis of acute pancreatitis.     

Clinical analysis of leg ulcers and gangrene in rheumatoid arthritis

Leg ulcers are often complicated in patients with rheumatoid arthritis (RA), however, the etiology is multifactorial. We examined the cases of leg ulceration or gangrene in seven RA patients who were hospitalized over the past 3 years. One patient was diagnosed as having pyoderma gangrenosum. Although vasculitis was suspected in three patients, no histological evidence was obtained from the skin specimens. In these patients, angiography revealed the stenosis or occlusion of digital arteries. In the remaining three patients, leg ulcers were considered to be due to venous insufficiency. Treatment should be chosen depending on the causes of leg ulcers.     

Receiver operating characteristic (ROC) analysis of images reconstructed with iterative expectation maximization algorithms

PURPOSE: The quality of images reconstructed by means of the maximum likelihood-expectation maximization (ML-EM) and ordered subset (OS)-EM algorithms, was examined with parameters such as the number of iterations and subsets, then compared with the quality of images reconstructed by the filtered back projection method. METHODS: Phantoms showing signals inside signals, which mimicked single-photon emission computed tomography (SPECT) images of cerebral blood flow and myocardial perfusion, and phantoms showing signals around the signals obtained by SPECT of bone and tumor were used for experiments. To determine signals for recognition, SPECT images in which the signals could be appropriately recognized with a combination of fewer iterations and subsets of different sizes and densities were evaluated by receiver operating characteristic (ROC) analysis. The results of ROC analysis were applied to myocardial phantom experiments and scintigraphy of myocardial perfusion. RESULTS: Taking the image processing time into consideration, good SPECT images were obtained by OS-EM at iteration No. 10 and subset 5. CONCLULSION: This study will be helpful for selection of parameters such as the number of iterations and subsets when using the ML-EM or OS-EM algorithms.     

Body cooling capacity of water circulated cooling pants during lower body exercise in a hot environment

We investigated the body cooling capacity of water-circulated cooling pants during lower body exercise in a hot environment. Five subjects were asked to ride a bicycle ergometer and to keep a work rate of 75 W continuously for 20 minutes. They then rest on the ergometer for 15 minutes, in a climate chamber kept at WBGT = 31.5 degrees C. They repeated the same procedure three times under three different conditions; 1) wearing cooling pants with cold water supply; 2) wearing cooling pants without water supply; 3) wearing short pants instead of cooling pants. Esophageal temperature and heart rate of the subjects, when their cooling pants were supplied with cold water, were lower compared with the condition without water supply, and were almost the same as the condition wearing short pants. Water-circulated cooling pants should effectively cool the body at work where the worker has to wear pants that cover his legs to prevent injury.